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Get Started With Dental Credentialing

by [email protected]

While running a practice, you may want to offer the finest patient care possible, and part of that may entail working with dental insurance companies. Dental Credentialing becomes important in this situation. It is the process of a dentist signing a contract with an insurance provider. Dental credentialing determines whether the practice is eligible for a contract as an in-network provider. Signing a contract agreement entails accepting the predetermined rates set by the insurance carrier so as to have access to a wider patient base.

Dental credentialing

After receiving a dental credentialing application, the insurance provider will examine and confirm the data. Once your application has been approved, you are bound by the contractual agreement with the insurance provider that stipulates you will adhere to their fee schedules, contractual constraints, and standards for patient copayments.

Credentialing your dental practice with dental insurance providers might seem challenging and complex. However, dental credentialing has become essential as it enables your patients to securely put their trust in the dental care provider of their choice. Dental credentialing additionally enables dental practices to connect with insurance providers so they can accept third-party payments. You can quickly become an in-network provider if you have established a relationship with an insurance carrier. The dental credentialing process can be a demanding task that needs to be approached with attention and organization, followed by constant and frequent follow-ups, in order to get it  processed on time.

Why is it so important?

Getting your practice credentialed is one of the first steps you need to take if you decide to accept insurance. Patients are 90% more likely to seek care from practices that are credentialed. This not only broadens your opportunities with potential patients, but it also helps promote your visibility online and in-network. It thus, gives your practice a better chance of attracting new patients. Also, it can be a mess if patients are under the assumption that a dentist is in-network with an insurance provider and that is not the case. Although dental credentialing initially takes up a lot of time, when done correctly, it saves a lot of time and helps reduce patient frustration.

Credentialing checklist

  • To acquire a credentialing application and learn more about the process, get in touch with a network provider. The application and other additional information are usually available on the websites of insurance providers.
  • Complete the application slowly and carefully, making sure to go through it thoroughly. Do not forget to include location information, copies of necessary papers, and other important information.
  • A detailed description of your practice location and any required paperwork, such as a business license, insurance policy, board certificates, etc., need to be updated in your profile.
  • Once you have submitted your application, keep a copy of it.
  • Verify that the insurance company received your application. After that, until you are informed that credentialing is finished and a participating provider agreement has been signed, periodically follow up to inquire about its status.
  • In order to speed up the process, respond quickly to requests for more information from the insurance company.
  • Maintain records of your submissions, follow-ups, and any other actions you deem necessary.
  • Keep track of all the contracts, applications, and submissions for credentialing, particularly the final version of the provider contract.

Common mistakes while credentialing

Sending claims with inaccurate provider data

Sending claims with the wrong provider information is a very serious error that could result in fraud charges.

Too late to begin the certification procedure

The procedure for obtaining credentials can take at least 90 days. This means you are not permitted to offer in-network services for three months. Since it can take several months, the application process should ideally begin earlier on.

Not conducting a prior analysis of your service area

Not doing any research into the most prevalent insurance payers in your service area is one of the most common mistakes. If you do not, patients may call to make an appointment, but go elsewhere for their treatment because you do not accept their insurance.

Failure to discuss the fee schedule

These are used to calculate the highest amount that can be charged to the patient and the highest amount their insurance will cover. As the highest dollar amount chargeable to the patient and to the insurance per service can be negotiated, do not blindly accept the first fee schedule you see.

Submitting applications to too many dental insurance providers at once

This can obviously bring in a lot of patients and money, but having too many applications open at the same time can be detrimental, as you may have to accept a lower fee schedule and your practice may have more work than your billing team can handle.

What happens when you have credentialed

You can start invoicing for in-network services after the credentialing process is finished. Confirm the patient’s insurance benefits prior to the visit and file claims within 24 hours after the treatment for prompt payment. Bill another insurance provider or the patient for any outstanding payments as soon as you get paid by the insurance provider.

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Filing Claims for Orthodontic Treatments

by [email protected]

Filing claims for orthodontic treatments can be a real pain if you don’t know what you are doing. Insurance providers have specific guidelines for the reimbursement of orthodontic claims as these treatments can span over multiple plan years. This makes processing these claims a complex task that requires some effort. Practices need to follow specific claim submission protocols to ensure that their claims get paid. If any of the information or documentation is incomplete or missing while submitting these claims, it can result in denials.

Steps involved in the submission of an orthodontic claim:

 Insurance eligibility and benefit verification

         The first stage in the process is to determine patient eligibility for orthodontic benefits. For dental insurance verification and coverage, get in touch with the patient or insurance provider, as orthodontic benefits vary greatly between different policies. The various pieces of information that need to be verified include details that are verified for regular dental services, like the name and date of birth of the patient, the name and contact information of the insurance provider, and also the insurance policy number. The practice also needs to get in touch with the insurance provider so as to learn the lifetime maximum, the percentage of the premium that the carrier is responsible for paying, the copayment and deductible, as well as any restrictions like age and dependency status. Keep in mind that all this needs to be carried out before the patient’s appointment.

 Coordination of benefits (COB)

         When a patient has dual coverage or is covered by multiple insurance plans, coordination of benefits becomes really crucial. Once the primary and secondary carriers are identified, claims need to be submitted in accordance with the rules that specify the sequence in which the dental practice must bill each health insurance plan.

 Claim submission

 While filing a reimbursement claim form that has been filled out completely, a statement outlining the treatment plan and the financial arrangements should be submitted. The documentation must include the estimated length of treatment, the payment plans, and the anticipated insurance payment, if any.

Information that needs to be included while submitting orthodontic claims:

●  The procedure code, together with a description of the appliance used and treatment.
●  The banding date.
●  The anticipated number of months during which the patient will undergo treatment.
●  The total amount you want to be paid for the services.

Points to be noted while reimbursing for orthodontic treatments:

 ●      The treatment expense needs to be related to the coverage duration. Reimbursing an entire orthodontic expense in one year usually violates the IRS requirement that the expense be spent during the coverage period because orthodontic expenses typically span two or more years. The cost of orthodontic treatment will be spread out over the duration of the treatment.

●   The patient should be receiving ongoing orthodontic treatment. Payments made after orthodontic treatment has ended are not eligible for reimbursement.

●      The entire expense of the orthodontic treatment cannot be fully reimbursed at the time of payment.

●      Payments may be made in monthly, quarterly, or annually over the duration of treatment, depending on the insurance provider.

●      If a patient is paying for an orthodontic treatment on a monthly basis, the monthly payments can be reimbursed as they are incurred.

●      Note that if adjustments or extractions are required to complete the orthodontic treatment, they will most likely be covered by the dental insurance. However, in rare instances, they will be billed from the orthodontic benefit.

Here are some tips on submitting orthodontic claims:

●  Diagnostic casts, photographs, or radiographic images need not be sent unless the insurance provider specifically requests them.
●  Make sure that claims are submitted with accurate, clean, and complete documentation.
●  Never submit orthodontic treatment along with general dentistry treatment on the same claim form.
●  Make sure to note down the start date–the date that braces are placed, appliances are fitted for the teeth, or aligners are delivered. This is a requirement for most insurance provider.
●  If the contract fee is less than the cost of orthodontic treatment, the insurance provider can be contacted to discuss options.
●  It is better to assign benefits to ensure that the insurance payments are received directly by the practice.

While these tips should generally help make the orthodontic claim preparation and submission easier and more streamlined, practices need to remember that each insurance provider could have specific requirements to accept orthodontic claims. Providers like Aetna and Delta Dental have their orthodontic claim submission requirements on their websites. Also consider that nothing can replace the eligibility and verifications process when ensuring that you prepare your claims accurately. 

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Managing Overpayments – Stabilizing your RCM

by [email protected]

Most dental practitioners spend a lot of time ensuring that they receive overdue payments as soon as possible. While this is obviously a necessary step to take, overpayments have also become a growing problem in the dental industry. Patients are often charged more than they should be for services and visits. Although overpayments can be made due to patient error, it is usually the insurance company that overpays. In both scenarios, overpayments need to be reimbursed without delays. How your practice manages the refund process will affect a patient’s overall impression of their dental practitioner.

 Some of the most common reasons for overpayment include:

●   Out of date patient eligibility and benefit information.
●   Incorrect billing due to changes in coding not being tracked.
●   Incorrect estimation of copays and coinsurance amounts at the time of service.
●   Changes in policy between the time of the dental visit and the billing process.
●   Errors in billing.
●   Overpayment by the patient.

  Avoiding overpayments

  Considering that prevention is better than cure, it is always advisable to avoid situations that could result in overpayment. One solution is for your practice to ensure that their coding is up-to-date and accurate. This can be done by regularly checking for coding updates and making sure that all claims are submitted with the right codes. Additionally, it is important to double check insurance information before submitting claims to ensure that the patient is not being charged more than they should. Other important ways include:

 Estimating your patient’s responsibility

Create a payment schedule for patients with larger balances so that the money can be collected over time. This will help your practice to track payments as they are made, which helps minimize overcollection. Establishing patient expectations and creating payment mechanisms to collect the payments or recurring balances, guarantees that your practice gets paid exactly what it is owed, nothing more and nothing less.

Checking for patient responsibility in real time

Before beginning the billing process, make sure the patient’s benefit details are up-to-date and accurately documented in your system. To ensure you have the most recent information possible, check the patient’s eligibility before each visit and dental appointment. Using outdated benefit information can result in incorrect billing, which can lead to patient overpayments.

Improving patient engagement

Patients are more likely to pay close attention to how much they owe when you involve them in the payment mechanism. Provide your patients with various payment options, as this helps increase their convenience. Patients are less likely to make payment mistakes and more likely to keep track of what they owe when they have control over their dental care payment process. 

What to do when overpayment occurs?

  Notify your patient about the overpayment. If the patient plans to return, check with them about crediting the excess amount towards their future visits or services. However, the excess payment must be returned if the patient doesn’t wish to use it for a future appointment. The next step is to quickly send the patient a check for the amount overpaid, along with a note explaining the situation of the overpayment.  Dental providers find themselves issuing refunds when there is a situation of overpayment. The manner in which a practice manages its refund procedure will affect the patient’s overall dental care experience. In order to provide their patients with ease and convenience, practices need to view the refund process as a crucial part of the patient’s dental care experience. In conclusion, overpayments are a growing problem in the dental care industry. Though there may be multiple reasons, identifying overpayment scenarios and addressing the issues on time can go a long way in reducing the number of occurrences.

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What You Need To Know About Insurance Verification And Authorization For Better Reimbursements

by [email protected]

There are several steps involved prior to providing dental services and the submission of claims. If not done accurately, these steps can lead to claim rejections and denials. The only way to prevent this is to verify that every aspect of preparing claims is accurate. Two processes that a lot of practices make errors in are verifications and pre-authorizations. Insurance verification and authorization belong to the initial, crucial stage of the RCM or dental claims billing process.

What exactly are insurance verification and authorization?

 Insurance verification

         Insurance verification is the process of confirming that a patient’s insurance policy or plan covers all the services that are scheduled to be provided. It involves confirming a patient’s insurance plan details and other information that will be required to submit the insurance claim. It is important to verify all the information, no matter how trivial it may seem, with the patient records so as to find any gaps or to determine the legitimacy of the claim. Even the smallest of mistakes, like a patient’s date of birth or a misspelt name can result in an immediate rejection.

 Insurance authorization

         Insurance or pre-authorization, on the other hand, is the process of getting approval from the insurance provider to perform specific services. The approval is to be sought before providing any treatment, as it determines whether or not you will get paid for the services provided. The chances of a claim being accepted or rejected are directly affected by this process. This is used by the insurance payer as an efficient means of ensuring quality and cost management while paying the claim.

 You will, most likely, need to submit a treatment plan to the insurance provider for review. This will include a detailed description of the proposed treatment as well as the estimated cost of services. They evaluate it according to predetermined criteria and carefully examine the request to determine whether the recommended treatment corresponds with the illness that the patient has complained about. If the insurance company approves of the treatment, they will issue an authorization letter, which confirms that they will pay for the services provided.

Difference between insurance verification and authorization

The pre-authorization process starts when the treatment for a patient needs pre-approval from the insurer, as opposed to insurance verification, which is carried out before submitting claims and before providing any of the service.

 Prior authorization is concerned with gaining prior approval for services, whereas insurance verification is concerned with the process of drafting and filing medical claims and receiving payment for patient care.

 Practice staff needs to be familiar with the CPT codes for the services for which pre-authorization is required for the process to run smoothly. Verification of insurance focuses on eligibility, active or inactive status, and coverage status.

Common challenges with insurance verification and authorization

Navigating insurance verification and authorization is an ongoing process and lapses can cause roadblocks in your RCM. The most common challenges with these are the inaccuracies in patient details and a lack of understanding of dental codes and coverage limitations. These challenges can often lead to patient dissatisfaction and uncollected payments.

Both processes can be time-consuming but once you have an effective system in place, the process becomes smooth and reduces glitches in your RCM. They can go a long way towards saving time, avoiding denials and delays, maximizing reimbursement, and improving patient care and satisfaction.

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It is time to clean up your old Accounts Receivable

by [email protected]

Collecting patients’ payments on time can be one of the most difficult parts of running a dental practice. Having old or aging accounts can indeed become a headache for your practice’s payment collections and management. Your practice needs to make sure that it is getting paid for the services provided and that the payment is collected from both the patients and the insurance provider. But often you see practices struggling to collect payments on time.

There are various explanations for why dental practices do not receive full payment. 

This includes:

  • The patient leaves a balance.
  • Insurance does not provide the expected coverage.
  • The patient discontinues payments under the established payment plan.

Now, why do you need to clean up your old accounts?

Accounts receivable is a major expense for dental practices which can easily go out of control. If accounts receivable get too high, it can even result in your practice being closed down. However, the good news is that regular cleaning up of accounts over the next 90 days will help your practice collect outstanding balances and limit bad debts, thereby preventing the accounts receivable from getting too high. Clearing old accounts on a regular basis also helps to make sure that not much time or money is spent chasing past-due patients’ balances and insurance balances. The goal of your practice should be to clear all accounts in accounts receivable that are older than 30 days.

Steps to cleaning up old accounts

Create a report

The first step to cleaning your old accounts is to create a report of accounts over the past 90 days. The likelihood of your practice collecting on overdue accounts decreases dramatically once they remain unpaid for such  long periods of time. This makes it important for practices to create a report of all the old accounts before they get written off.

Clean up patient data

Making sure that your patient data is clean and accurate is highly important for ensuring that your claims get paid on time. Any mistakes or inaccuracies in it can lead to payments getting delayed or worse, claims getting denied altogether.

Therefore:

  • Check for any duplicates
  • Check for missing information
  • Check for inaccuracies or errors
  • Check for inaccurate patient demographics
  • Check if the patient data are up-to-date

Review pending patient payments

Reviewing pending payments helps your practice get an idea of what went wrong, whether it is a mistake from your part or the insurance provider or the patient. Reviewing payments within the last 30 days will help you know if any payments have been forgotten or if there is some kind of problem with one of the insurance providers.

Send friendly reminders

The best way to stay organized and on top of the numerous patient payments is to send timely reminders via text messages, emails or phone calls. This helps your practice make sure that none of the payments go unpaid. It can be the best means to remind your patients of their payments, as there are high chances that they might forget about the payment.

Make follow-up calls

This is the last step in cleaning up the old accounts. It is the part where you call the patients to remind them of the payments and convince them to pay the due amount. There may be a lot of reasons that keep your patients from making the payments. This is your chance to talk to them and understand what is stopping them from making the payments so as to make the necessary changes to make payments easier for your patients, if possible.

Here are a few tips to clean up your unhealthy accounts receivable:

Collect payments on or before the day of treatment

Make sure to collect patient payments before providing the services so as to make sure that none of it goes unpaid. Collecting payments prior to providing services also helps reduce no-shows and cancellations. If you are not able to collect it at the time of scheduling, do so before the patient returns for treatment, especially if their appointment is long or challenging.

Avoid surprises

Before beginning treatment, explain the treatment plan and the anticipated cost to your patients. Have current eligibility information, a summary of benefits, and the insurance fee schedule on hand for the patient. Avoid surprises as it may ruin their experience, making them lose trust in your practice and not want to visit again.

Provide constant reminders

Provide constant reminders to your patient so as to make sure that they do not forget about their payments that are due. Make sure to call the patient if payment is not made by the due date. Even better, send them a text or email with a link to a payment page so they may pay the remainder online quickly and conveniently.

Offer various payment options

Make sure that it is easier for the patients to make the payment by offering them various payment options. In addition to accepting cash, checks, and charge cards, allow your patients the convenience of making payments online. Thus helping your practice collect payments faster and easier.

Cleaning up old accounts can be a great way for your practice to collect on outstanding balances and reducing bad debts. The key is to do it regularly and make sure you have a plan in place before starting.

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Dental Insurance Waiting Period – What You Need To Know

by [email protected]

Dental billing is an important part of maintaining the steady health of your dental practice, but it can also be confusing and tiring. Understanding your patients’ insurance coverage and waiting period is essential to ensuring that you get the most out of their policy. Knowing what to expect during the waiting period and what services are covered can help your practice make the most of the patient’s dental insurance. Therefore, it becomes highly important to understand and take into account your patient’s insurance waiting period.

So, what exactly is a dental insurance waiting period?

The waiting period is the amount of time your practice or the patient needs to wait between the purchase of the insurance plan and the date the services are completely covered. This period varies from plan to plan. The length of a waiting period for dental benefits might range from a few months to a full year, depending on the type of plan you’ve chosen and the details of your insurance policy. So it is important to understand the specifics of the policy. There are chances that the dental insurance may not cover certain procedures while the waiting period for the dental plan is in effect. Also, not all dental insurance companies have a waiting period. Waiting periods for dental insurance aid in containing your patient’s overall dental insurance expenses. They stop your patients from getting expensive dental work done and then canceling their coverage soon after, which raises everyone’s costs. In essence, waiting periods assist in keeping the cost of dental insurance reasonable for all your patients.

Services covered during the waiting period

Understanding which procedures require a waiting period before providing the services can help your practice in the long run. Therefore, it is important to contact the insurance provider if you have any doubts regarding the services covered under the waiting period. Keep in mind that some plans have longer waiting periods than others. Here are some of the treatment categories for waiting periods:

Preventive

Preventive care is usually not subject to a waiting period under most dental insurance policies. These include checkups, cleanings, x-rays, etc.

Basic 

Basic procedures like non-surgical extractions or fillings may have a three to six months’ waiting period.

Major dental works

Major dental work like dentures, bridges, and crowns may have a three months to one year’s waiting period.

How is the dental insurance waiting period a limitation?

Most patients only need the insurance for a limited period of time. Since insurance firms are aware of this. Waiting periods protect them against such circumstances. There are waiting periods in some insurance plans, but not in all of them. Waiting periods are a way to limit how much insurance money a patient can get in reimbursement over the course of the plan’s implementation. As a result, insurance costs are reduced for both your patients and your practice. However, during insurance verification, it is crucial to inquire if a patient has a waiting period as waiting periods can delay patient treatment payment collection, thus affecting the overall revenue collection at your practice. The patient will be required to pay out of pocket for the procedure if neither the patient nor the dentist are aware of the waiting period and the insurance does not cover the cost. We can almost certainly predict that the patient  will not be thrilled by such surprises that they  are not prepared for. This can negatively impact their experience at your practice. As a result, unexpected waiting periods in dental insurance plans can prevent your practice from receiving payment for services rendered.

Common mistakes when it comes to waiting periods.

The most common mistake that the practice as well as the patients make when it comes to waiting periods is not being prepared for them. Another important mistake they make is assuming that waiting periods are the same for all plans.

What should you do about the waiting periods of patients’ insurance plans?

Make it a priority at your practice to ask the insurance provider if the patient has a waiting period in their plan during the time of verification. Also, make sure to collect information or details regarding the waiting periods as you need to inform your patients regarding their waiting period before providing any services. If you do not, the patient is likely to hold you responsible if the insurance company does not cover for the procedure. Upset patients and possible financial loss could be the result of this.

Your practice needs to be aware of the different types of waiting periods, what they are, and how they work. It is also critical to understand what services are covered during the waiting period in order to plan accordingly so that the revenue cycle of your practice does not get affected and the practice runs smoothly.

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Tracking Your Claim Status

by [email protected]

Nothing in a dental practice is more upsetting than learning that your dental insurance claim was rejected or wasn’t reimbursed fully. Which means you have to go back and figure out what went wrong. However, the majority of medical practices rely heavily on insurance payments, so it’s crucial to monitor claims and look into the causes of rejections, even if it is time consuming. In most cases, practices have to wait for EOBs (Explanation of Benefits) before identifying the errors or mistakes in claims. However, with proper tracking practices, we can detect errors in claims early on and take the required action to ensure that claims are processed promptly.

The claims billing process at your practice doesn’t end with successfully submitting the claims. To handle challenges like the payment of smaller claim amounts, erroneous fund redirection, rejection of the ID you have provided, and to answer any inquiries from the insurance provider, your practice needs to be actively involved in the dental insurance claim process. It is really important to keep tabs on the progress of your insurance claim, as it enables your practice to stay informed about the claim’s status and learn about any delays or obstacles that may have occurred during the claim’s processing. When checking for the status of your claims, you may come across different claim status types, and each may require different action.

Here are some of the claim statuses you can come across:

Approved

This means that the claim has been approved by the insurance provider, and all you have to do now is to wait for the payment of your claim.

Under process

This means that your claim has not yet been processed, and you need to keep a continuous check on it to make sure that it gets approved.

Details required / Issues

This means that you have to contact your insurance provider and submit the necessary additional documents so that the insurance provider can continue with the claim processing.

Rejected

This means that your claim has been rejected, and you now need to contact the insurance provider and find out the reason for the denial. You can file an appeal if you think that there was an error while processing the claim. 

What are the benefits of tracking your dental claims?

Helps prioritize denials

With continuous tracking of claims, your practice does not have to wait for the explanation of benefits to take action against denials. Tracking your unpaid claims helps identify the reasons for denial, thus helping you correct the mistakes or errors and appeal claims without much delay. Tracking unpaid claims gives your practice the chance to work on them early on and prevent the claims from going unpaid.

Helps identify red flags

Continuous and thorough tracking of claims helps in identifying patterns in claim underpayments or denials. It is crucial for practices to identify internal issues or trends that might be contributing to these denials. These can be considered learning opportunities that will help avoid repeating the same mistakes that lead to claim denials.

Helps pursue appeals

Since tracking claims helps you identify unpaid claims and reasons for denials early on, it thereby helps practices submit appeals faster and much easier. Your claim appeals can be accurate and efficient with claims tracking, as it helps you identify the errors early on and fix them quickly.

Increase in revenue

Proper tracking of claims helps your practice submit claims efficiently and on time, increasing the clean claim rate and thereby increasing the overall income at your practice. It also helps in making sure that no claim goes unpaid or unnoticed. Even the ones that get denied are appealed for on time.

Here are some tips to improve the tracking of claims at your practice:

  • Obtain the most up-to-date claim status.
  • Work on your dental insurance aging report at least once a week.
  • Keep an eye on your average monthly production and your total accounts receivable.
  • Follow-up on all dental claims that are more than 30 days old.

The main aim of submitting a claim is to get reimbursed for the services provided. While promptly filing a claim with your insurance provider is essential, it’s also critical to monitor the status of your claim. This ensures that action is taken on time, regardless of the issues with your claims.

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Leveraging Recalls for better practice management

by [email protected]

Patient retention rates at a practice should ideally be between 85% and 95%, and if your practice is nowhere near that range, it’s a sure sign that your recall mechanism needs to be refined. A lot of practices rarely realize the importance of a strong recall system and think it’s unnecessary. As a result, their patient retention rate falls unnecessarily low. It’s important to spend some time working on your recall system if you want to get the once-active patients back in your books. Neglecting the recall system will, most definitely, hurt your practice.

Here’s how ignoring recalls can hurt your practice:

Losing patients

While it’s important to attract new patients, it’s also very important to retain the already-existing ones. A lot of times, patients are never heard from again after their appointments. Without a perfect recall system, practices are most likely to lose these patients as you lose any chance of building a bond with your patients. 

Losing patient referrals

Patients who haven’t visited the practice in a while probably won’t recommend it to their friends and family either. That’s a missed opportunity, which can cost the practice a lot of money. 

Broken appointments

A couple of missed appointments may not seem like a problem. However, cancellations and no-shows tend to become a common occurrence if they go unchecked. This obviously leads to loss of revenue. 

Loss of revenue

Without a recall system, patients would most likely not prioritize overdue payments. This is sure to result in your practice suffering losses.

Here are some of the benefits of prioritizing recalls:

Increase in patient retention rates

Prioritizing your recalls can work wonders in increasing the patient retention rates at your practice. Having a strong recall system helps you give your patients the best service that is possible; whether they are current clients or new ones. Recalling your patients to inform them about their condition, reminding them about their pending payments, and educating them about the various payment options available helps improve the practice-patient relationship.

Increase in referrals

A loyal patient is most likely to refer their friends and family to a practitioner they trust. This is especially true if you are able to provide exceptional treatment and a great patient experience.

Reduced no-shows and broken appointments

No practice wants to deal with the hassles of last-minute cancellations and no-shows. However, it is only natural for patients to forget their appointments in the midst of their busy schedule and not show up for their treatments. With an effective recall system, such incidents can be avoided to a great extent, as it gives your patients constant reminders for their appointments and payment responsibilities.

Boost practice-patient relationships

Patients need to feel valued. Reaching out to your patients through recall, ensuring their oral health, and providing up-to-date information shows them how much they are valued at your practice. This helps in building a stronger bond and in building trust.  

Increase in revenue

The more patients your practice has, the more revenue it makes. By making recall a priority at your practice, you will put patients who were previously inactive back in your books. Your patients will also be reminded of their payment responsibilities. The improved on-time payments cycle will increase the overall cash flow at your practice.

In summary, patient recall helps a practice maintain ongoing patient care, increase patient retention, and reduce no-show rates.  Recalls give your practice the opportunity to talk to your patients about their dental health, remind them about their appointments, and also educate them on their payment responsibilities. This extra effort makes your patient feel special and valued, enhancing the trust that they have in your practice. Recall is important, and ignoring it is detrimental to a healthy revenue cycle.

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Understand How Copays, Deductibles, And Coinsurance Work

by [email protected]

A major part of having dental insurance is the cost sharing or out-of-pocket expenses that all insurance providers require patients to meet. Along with the premiums, members are also responsible for the copays, deductibles and coinsurance. Understanding how they are applied is vital for patients to plan their annual dental insurance costs. As a dental practitioner, one additional step that you can take to enhance patient experience is to educate them about their out-of-pocket expenses.

Deductible

Dental plans require that patients first pay for their dental services up to a fixed amount before the insurance provider starts paying for their covered services. This fixed amount resets annually and is called a deductible. Patients are completely responsible for their dental care expenses until they reach their deductible amount. However, preventive care, such as checkups, X-rays, and cleanings, are typically covered in full by the insurance plan. So, say your patient’s plan has an annual deductible of $100. If your patient comes in for a routine cleaning, the service may be covered in full by the insurance provider even if the deductible amount has not been met for that year. Some plans also have separate deductible amounts depending on whether you, as a dental rcm provider, are within network or out of network. 

Key points to note about deductibles:

  • Deductibles may not apply to all services
  • Separate deductibles apply to specific services under some plans.
  • Family plans typically have both an individual deductible that is applicable to each member of the family and a family deductible. 

Copay

Simply put, a copay or copayment is a fixed fee that your patient pays for each visit of specific covered services. Copays may not apply to all covered services and may vary depending on what service the patient comes in for. The amount also remains the same regardless of the final bill that you as the dental provider raise. A patient could have a $10 copay for a routine check up, no copays for cleaning and a $150 copay for emergency visits. Let’s say your patient has had two dental emergency visits with you during a policy year. The cost for each visit may be different. However, your patient would have to pay $150 as the copay for each of the emergency visits. The remaining is paid by the insurance provider. Copays typically apply even if the patient has met their annual deductible. Copayment amounts could change depending on your network status with their insurance provider. 

Coinsurance

Coinsurance is a percentage that your patient pays for dental services once their annual deductible has been met. The remaining amount is paid by the insurance provider. If the coinsurance percentage for your patient’s plan is set at 20%, the remaining 80% would be paid by the insurance provider. Coinsurance percentages may vary depending on the services the patient receives. Amounts could also vary depending on whether you are within network or out of network with their insurance provider. 

How it works

Out-of-pocket expenses and other charges may vary depending on the dental insurance provider. Typically, patients pay their premiums to have dental insurance. Each time your patient visits, they may pay a copay, which may or may not add to their annual deductible amount. Once the deductible amount is met for that year, the coinsurance percentage that the patient needs to pay, kicks in. The copay and coinsurance amounts need to be paid till the out-of-pocket maximum for that particular year has been met. The insurance provider then typically pays 100% of all the charges till the annual maximum is met or till the policy year ends. 

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Why Do Practices Hesitate In Partnering With an RCM Service Provider ?

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The complex and crucial area of revenue cycle management takes a lot of effort and time in your practice. Submitting and following up on dental claims to get reimbursed for the services provided can indeed be exhausting. Additionally, the proper management of the revenue cycle helps make sure that the practices get paid for the services rendered. Therefore, it is crucial to have skilled billers who can improve revenue for the company. Which is why it is time for practices to consider an RCM partnership. When practices first consider RCM collaborations, terms like “outsourcing,” which most practitioners fear, often come to mind. These fears may prevent your practice from fully appreciating the advantages of outsourcing dental billing.

Here are some of the common worries that prevent practices from partnering with an RCM provider:

Fear of layoffs

The worry of losing their jobs once an external RCM provider is hired is very common among the staff at your practice. The concept of someone else handling the billing process can undermine their worth at the practice as they are so accustomed to handling it themselves. It makes them feel threatened about their job at the practice. Dental billing, as you already know, is a complex and tiring process, and an RCM provider only helps lessen the workload of your staff. The RCM service provider functions as an extension of the billing team; they work on your insurance claims behind the scenes while your practice staff remain front and center.

Loss of control over the revenue cycle

Another common fear present among most practices is the fear of losing control over their revenue cycle, which stops them from partnering with an Revenue Cycle Management provider. Practices often find it difficult to trust an RCM provider to complete the work in the desired manner and on time. However, the fear is not valid at all, as you are not really losing control when you let a professional handle your bills; instead, you are assigning the more time-consuming task to a third party while using your own time more effectively on more important tasks at your practice. By partnering with an RCM service provider, you get access to a skilled and knowledgeable billing team that helps you submit more accurate claims on time, boosting your collections.

Loss of revenue due to the cost of partnering with an RCM provider

The cost of partnering with an RCM provider is another facet / element that practices fear. Although it can seem like partnering with an RCM service provider will cost you more money, that is not true at all, as it only helps boost your practice revenue significantly. Expert RCM service providers often help practices save money by streamlining the revenue cycle. Furthermore, for most practices, the cost of salaries, benefits, and office expenses exceed(s) the cost of opting for a service provider. Therefore, the most cost-effective way to simplify your billing process and generate successful claims is to partner with a service provider.

Revealing confidential information to third-party service providers

Data security and regulatory compliance are top priorities at a practice, which is why practices may be hesitant to form partnerships. They may be concerned that the new third party will not be able to protect data in the same secure manner. As they are entrusted with securing such a huge volume of Patient Health Information (PHI), leading RCM outsourcing suppliers place high priority on data security and regulatory compliance.

Only large practices can partner with an RCM provider

There is a common stigma among practices that only big and well-established practices can partner with an RCM service provider. Although medical billing providers prefer larger clients, they do not exclude smaller or lesser-known practices from their services. The majority of revenue cycle management providers’ customers are small and medium-sized practices.

Partnering with an RCM provider is time-consuming

Many practices are under the misconception that partnering with an RCM service provider takes up a lot of time. In actuality, partnering with a service provider presents you with the opportunity to spend more time working on the other needs of your practice and less time worrying about the financial aspects. The service provider generally submits claims faster than your employees since their work is solely focused on billing and they don’t have to manage the other needs of your practice . They can also quickly locate denied or rejected claims, ensuring that you don’t miss any deadlines for filing appeals and thus, leading to faster dental billing, contrary to common belief.

Opting for a service provider may reduce patient satisfaction

Another aspect that restrains practices from partnering with a service provider is the fear that it would affect their patient satisfaction because the patients would prefer in-house billing, but this is far from the actual case / truth. Partnering with a service provider helps your staff devote more time to patient care. They can now focus more of their time and attention on improving patient care because they are no longer required to work on the time-consuming RCM processes. This in turn leads to strong levels of patient loyalty and satisfaction.

An RCM partnership is actually an added assistance that can lead to success for the company, its staff, and its patients. Understand that you can be losing out on a sizable portion of the practice’s income from unpaid claims if your fears prevent you from even attempting to partner with an RCM provider.

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Stop Letting Poor Dental Coding Ruin Your Practice’s Revenue Cycle

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Dental codes and their power to accurately code various procedures for insurance reimbursements are a major source of worry for many dental practices. For the same reason, utilizing the proper dental procedure code is essential, yet quite puzzling. Accurate dental coding is vital to submitting clean claims for timely reimbursements. Practices need to make sure the appropriate dental codes are added to the bill when creating one. Also, they need to bill the claims accurately using the most recent CDT code sets so as to minimize problems, discrepancies, and other payment barriers.

CDT codes are a series of medical codes for procedures that deal with both oral health and dentistry. These procedural codes are alphanumeric codes that start with the letter “D” and are followed by four numbers. It contains the necessary codes required to code each dental procedure for submission to a particular dental insurance plan. It is important to understand that the CDT codes undergo changes every year, and a practice must be up-to-date on the changes to the CDT codes.

The CDT code set is divided into different service types, which include:

  • Diagnostic
  • Preventive
  • Restorative
  • Endodontics
  • Periodontics
  • Removable Prosthodontics
  • Maxillofacial Prosthetics
  • Implant Services
  • Fixed Prosthodontics
  • Oral and Maxillofacial Surgery
  • Orthodontics
  • Adjunctive General Services

Submitting claims with accurate dental procedural codes is not an easy task; it has a lot of difficulties, which are further exacerbated by  limited staff and time. Understand that your staff are not robots; they can make mistakes too. There are high chances for them to miss adding some of the dental codes to the bills, especially with their busy schedule. A lot of reasons, including time constraints, extra workload, etc., can lead to mistakes in dental coding.
Failure to use the appropriate procedure codes can complicate the entire process and result in negative patient outcomes. It is true that precise procedural coding is a legal necessity, and violators  have to face severe repercussions.

When process codes are misused intentionally or unintentionally, the practices have to face a lot of challenges, including:

Delayed or denied payments

Failure to provide correct coding can lead to improper billing, causing payments to be delayed, denied, or limited. A majority of claims get denied due to such errors in procedural coding. Such claim denials can be costly, as the buildup of these denied reimbursements can result in heavy loss of revenue at your practice.

Hinders patient satisfaction

Even a small error in dental coding, such as switching the order of two digits in a code, can indicate a completely different diagnosis. Patients may think there is a scam afoot if they receive a hefty fee for a procedure they did not have. This may result in claim denials or delays that negatively impact your patient experience.

Leads to fraud and abuse fines

Improper coding on claims may have legal repercussions in addition to regulatory liabilities if the insurance carrier challenges the accuracy of the procedures submitted. If an insurance provider finds out that a practice has routinely overcharged or overtreated a patient, the practice will be subjected to disciplinary action.

Your practice can’t afford to lose tens of thousands of dollars due to unnecessary errors or inefficiencies. However, that is exactly what happens if you are using inaccurate or outdated dental codes. Therefore, it’s your practice’s responsibility to make sure that the claims are correctly coded.

So, here are some ways in which you can reduce the inaccuracies in dental coding:

Perform regular coding audits

Regular coding audits are necessary for the proper and accurate coding of dental bills to make sure that your practice receives timely reimbursements. Performing regular coding audits helps you identify areas of inefficiency in your coding process, thus providing the opportunity to find solutions to rectify the most common mistakes in coding.

Stay up-to-date on the latest CDT codes

As mentioned earlier, CDT codes undergo changes every year, so it is important for your practice to stay updated on the latest changes as dental coding mistakes can have severe repercussions.

Always check for fraud

Make sure that you check for any kind of fraud in your dental billing before submitting the claims. If the insurance companies suspect any misuse or abuse of procedure codes, your practice can face disciplinary action. It is crucial to remember that your practice is legally responsible for the accuracy of all dental claims that leave it.

Clear communication

For the accurate coding of dental bills, practices must make sure that the necessary information is thoroughly communicated between the provider and the billing staff. For accurate and proper coding of dental bills, the provider must clearly communicate and explain the treatments performed on patients to the billing staff. The practice could suffer financial loss or even face legal repercussions for inaccurate coding due to a lack of proper communication between the provider and the office staff. Keep in mind that coding errors are more likely to occur in practices with poor communication, which can be quite problematic.

However, keep in mind that everyone at your practice must be aware of the updated CDT codes, not just the billing staff. It can be helpful to your staff in identifying scenarios where the codes may be applicable, recognizing when it is necessary to gather more information on a particular procedure, and fully documenting the procedures so that they are eligible for billing whenever possible.

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Enhance Accuracy and Consistency With Charge Capture

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Revenue Cycle management is an area that demands and receives frequent attention, but the surprising fact is that charge capture in RCM often goes unnoticed. Nevertheless, charge capture is a critical factor in the revenue cycle process, as dental practices risk losing millions of dollars in revenue if they do not accurately record data on the services rendered at their practice. “Revenue leakage” refers to situations where a healthcare provider has issued care and services to a patient, but does not receive payment.

Charge capture refers to the practice of documenting and recording the various services rendered to patients by the healthcare provider. These are then sent out to the insurance companies for reimbursement. It is one of the first steps in revenue cycle management, and any error at this stage can lead to claim denials.

Incomplete, un-billed or inaccurate claims submitted to the payer for treatments rendered to patients, result in the loss of more revenue than any other reason.

Challenges or Difficulties with charge capture :

Missing, Incomplete, or Inaccurate Documentation

While recording treatment details for a lot of patients, there is a huge chance for some details or information to go missing, be incomplete, or be inaccurate. This can become an obstacle to the effective functioning of your revenue cycle.

Not Documenting  All Services Rendered

Practices, in their hurry because of the tight schedules, may at times forget or skip documenting some of the services provided, which may result in claim denials and payments going unpaid.

Sudden Patient Visits or Inpatient Consultations

Unexpected patient visits or inpatient consultations can create disturbances in the charge capture process.

Typos in Documentation

Typos in the information documented may seem like a simple mistake, but they can have a huge impact on your revenue cycle as they result  in claim denials.

Long Documentation Gaps

While it is ideal to capture charges within 24 hours, coding staff frequently take too long to complete medical coding resulting in documentation gaps, in turn, prompting an increase in claim denials and redundant billing delays.

Benefits of having an effective charge capture system :

Identifying revenue leaks
An expert sharp eye can find any cracks in charge capture that would result in revenue leakage.

Timely submission of claims
Effective charge capture helps your practice submit a perfectly completed claim in the claims submission process well within the timely filing period.

Improved accuracy optimizes revenue
With an effective charge capture system helping your practice collect accurate and complete details of the services provided to patients, you can submit claims with the utmost accuracy.

Best practices involved in charge capture :

Eliminate legibility concerns

Place emphasis on accurate explanation of rendered services as they are provided to the patients and avoid any kind of legibility issues. This could be mistakes in the spelling and grammar.

Provide accuracy in coding

Emphasize coding accuracy so as to improve revenue and reduce the possibility of denials due to coding errors.

Set target goals

Make it your objective to collect payments within 24 hours, if not less, and strive to achieve the targeted goal. However, make sure that you collect the necessary data to identify if you have made any progress and make changes accordingly.

Conduct audits

A system audit can be valuable as it enables your practice staff to concentrate exclusively on identifying the source of inconsistencies. It helps in uncovering erroneous billing practices and coding problems, both of which can contribute to accurate patient billing. This eventually leads to higher patient satisfaction.

Align your teams

For accurate and effective charge capture, it is important for your practice staff to work together – right from the providers to the staff, everyone should align. This helps in avoiding any kind of confusion that may arise between the providers and staff, thus helping in accurate and correct charge capture.

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A Healthy Denial Management System Within RCM

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The average claim denial rate has risen considerably over the past few years. This means that there is an increase in the number of payments getting delayed or unpaid, leading to a loss in revenue and disturbing a practice’s overall revenue flow. Practices often make the mistake of blaming insurers for claim denials, but it would in fact be a better use of time to analyze the denial management strategy that is being used. There are also times when they make the mistake of not following up on denied claims, leading to an additional loss of revenue.

What is denial management?

Denial management includes identifying and correcting registration, claims billing, and medical coding flaws through trend tracking in order to develop the best solutions for reducing the number of denials. It focuses on identifying the reasons for denials and developing solutions to either reduce the risk or avoid them entirely. It helps mitigate the chances for future denials, thus ensuring that a practice receives quicker payments and a steadfast cash flow.

What are the steps involved in denial management?

Identifying the root cause of denials

The real difficulty in denial management lies in identifying the root cause of most denials. Identifying the causes, especially the recurring ones, is really important for managing denials productively. Claim denials can happen for a lot of reasons, including late claim submission, duplicate claim submission, incorrect or missing patient data, services not covered by the plan, incorrect documentation, etc. Identifying the most common cause for denials will help the practice to take steps to correct the disconnect. 

Monitoring and tracking the denials

Another integral step in denial management is the monitoring and tracking of denials. It is important to have accurate records of the denied claims. This can be done according to the type, date of service, procedure codes used, patient name etc. Additionally, tracking can be done for each insurer that you file with. Maintaining the tracked date on the basis of time, source, number, and reason for denial can help with effective communication with the insurers. This aids in lowering the likelihood of future claim denials.

Managing denials

The next step is the actual resolution and the resubmission of claims. Managing the denials, however, is itself a multi-step process. It involves tracking all the claim denials, sorting through them to understand the different reasons for these denials and then creating a streamlined process to rectify them, if possible. The denial management  process then gets implemented and utilized each time there are denials and this needs to be done in as little a time as possible to avoid.

Data Analysis In Revenue Cycle Management

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Revenue cycle management maintains and operates the financial health of a dental practice and the challenges of running a healthy revenue cycle can be plenty. From accurately entering claim data and information to initiating claims billing process to securing reimbursement and payments, several steps are involved in managing the revenue cycle of a practice. Inefficient dental revenue cycle management can put your practice at risk, as it not only hinders your practice’s growth but also results in a negative patient experience. Finding a solution for your RCM-related worries can be like attempting to find a needle in a haystack if a thorough understanding of where those problems occur is not achieved. Practices need to dig deeper into their revenue management if they truly want to fix their revenue cycle management and get back on the track of profitability and security.

This is where data analytics comes in; it offers you an insight into how precisely your  dental revenue cycle management  is running and where the difficulties lie. It also provides insights into everyday operations and projections of future trends and functions. This helps to make data-driven decisions and correct issues even before they occur. Such data-driven insights are required on a variety of topics, from profitability to the intricate analysis of lost revenue.

Data can be analyzed in three ways:

Descriptive

Descriptive analysis basically gives your practice the answer to the question, “What happened?” This is the threshold that practices should begin with as it is the simplest to perform. It mainly involves gathering and analyzing historical data about your practice. This provides you with information on potential revenue leaks caused by problems with insurance carriers, internal operations and the like. 

Diagnostic 

Diagnostic analysis helps answer the question, “Why did it happen?” It basically unearths links between all the data collected and helps your practice pinpoint what led to the problem in the first place. Identifying the cause of the problem and any connections with other problems will help you take action accordingly. 

Predictive

Predictive analysis, on the other hand, provides your practice with an answer to the question, “What could possibly happen?” It takes the historical data collected, analyzes the patterns found, and then predicts future trends in the revenue flow of the organization. The practice can adjust its present revenue cycle billing method to reflect the trends identified from this analysis. This is also the type of analytics that a lot of practices use machine learning or artificial intelligence to perform. 

Prescriptive

Prescriptive analysis is the most advanced form of analysis and it answers the question, “what should the practice do?” It makes one or more recommendations based on collected data, allowing the user to consider the potential results of each suggested course of action. The accuracy of prescriptive analysis depends heavily on the accuracy of the earlier steps and hence can be the most difficult to perform. The end result, however, is of high import and is undeniably a powerful tool for dental revenue cycle management. 

From improving your practice revenue to creating a better patient experience, data analytics can benefit your practice in a lot of ways. 

Some of the main benefits include:

Reducing minor errors

Data analytics helps validate the data collected during the revenue cycle management process. It scrubs your data for any minor errors, and compares the collected data to the information from the insurance provider.

Understanding your RCM better

Data analytics helps your practice identify and breakdown its revenue cycle process, thus letting you understand your  dental revenue cycle management better. It also gives your practice a clear picture of each step involved in RCM, thereby making it easier to identify any one that is not performed accurately. With this, you can finally assess and benchmark your RCM dental revenue cycle management processes. You can now create appealing reports that provide a complete picture of the actual state of your revenue cycle. It becomes much easier to improve your practice’s profitability when you can identify the main cause of a trend that results in decreased profitability.

Determining key performance indicators

KPIs provide essential data on healthcare revenue. They keep a close eye on the claims processing to spot any errors and also assess the denial rates for improved reimbursements. KPIs are very important for the growth of your dental revenue cycle management and these KPIs can only be identified through proper data analysis. Only through a thorough data analysis can the trends in the revenue cycle and the areas that need improvement be identified.

Improving patient experience

With proper data analysis, patient payment collection can be made a lot easier, giving you more time to focus on patient care and treatment. Your patient experience can improve exponentially when you have sufficient data collected through data analysis and understand how payment collection can be improved without causing any inconvenience to them.

Reducing denials

You can quickly identify patients and insurance companies that have frequent denials and rejections by incorporating data analytics into your dental revenue cycle management. This helps your practice improve its revenue flow by lowering its denial rate. Additionally, with proper data analysis, you can easily identify the frequent trends in denials, thereby making sure that you don’t endure similar denials or rejections in the future. Thus increasing your claim acceptance rate.

Understanding the performance of your revenue cycle is crucial for the steady growth of your practice. Remember, it is vital to remain on top of trends and benefit from utilizing data analysis in its entirety. Data analysis can provide insights into your practice that can help you make better decisions, increase revenue, operate more efficiently, and improve patient care.

Create A Great Patient Retention Strategy

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A lot of practices spend an exorbitant amount of time marketing for new patients. This seems logical as the more patients you get, the more your revenue, right? Not really. Sure, it’s great to have a lot of new patients but what is happening to the ones you already have? Are you spending sufficient time and resources on making sure that these patients are opting your practice for dental services that you offer?  

The truth is that your efforts to bring in new patients will only be effective if you can successfully retain your current patients, keep them satisfied, and even happy. In this time of perpetual competition, changing insurance plans, and the intrusion of social media, it has become increasingly challenging for many practices to retain their patients. Patient loyalty is an intangible asset that leads to patient retention, and it doesn’t happen overnight. Time and patience is crucial to creating an effective patient retention strategy. Attracting new patients is important for the growth of your practice. However, not being able to retain these patients means that you are not gaining the full value of all your marketing strategies. Basically, the higher the patient satisfaction, the higher the patient retention, and consequently, the greater your revenue. 

Here are some of the best strategies or tips to retain your patients:

1. Focus on the best quality treatment

When it comes down to it, the quality of your dental service is what can speak volumes for your practice. Patients visit your practice to get the best treatment, and if they don’t receive quality treatment, they are sure to look for other options. Therefore, if patient retention is your priority, you should be on providing quality treatment. Ensuring that you stay on top of new treatments and innovations in dental care will have a great impact on your patients remaining loyal to you. 

2. Provide an exceptional patient experience

Providing quality dental care may be a no-brainer but going the extra mile and providing value additions will go a long way to making a remarkable impression on your patients. Your patients have several options to choose from and it is quite easy for them to move from one practice to another. Creating a personalized dental plan, attention to detail on your patient’s preferences, initiating loyalty programs and holiday discount offers, early-bird offers, can all be catalysts for your patients to stay loyal to you helping increase patient retention rates at your practice. 

The ambiance that your practice provides can also have an impact on your patients. Consider upgrading your waiting area to make the ambiance feel warm and welcoming as opposed to being clinical. Simple things like providing ample parking areas can also have a huge impact on patient experience. 

Friendly, polite, and professional staff adds value to your logistical efforts. Train your staff periodically so that they are up to date on dental care and maintain professionalism even in touchy situations. Being approachable and returning phone calls on time are also aspects that your staff need to be aware of to make a positive impression on your patients. These are effective patient retention techniques that improve the overall outcome of your dental practice over time.

Additionally, you could also explore the feasibility of being accessible after hours. 

3. Establish a channel of communication with your patients

Establishing a transparent and continuous channel of communication is a crucial first step in patient retention. From registration to follow-up visits, there is a lot of information that needs to flow – back and forth – with your patients. This can include everything from giving them an idea of what to expect when they visit, the procedures they are likely to need, the patient responsibility, and right up to routines they can establish at home for better dental health. Establish your communication channels at the outset of your relationship with your patient. There may be a lot of information that a patient needs to plan out their dental care. Become a source for health-related information and help them reduce their information tracking needs. Over time, this practice, alongside an excellent patient renetion strategy in place will aid in gaining credence for your dental practice. 

4. Automate appointments, billing, and payment

One marketing strategy that can be utilized to positively influence your patients and build patient retention levels is to have a professional website set up. Your website can be a one-stop destination for your patients to get updated information about your services and dental know-how, book appointments and pay bills. Having an online appointment system available will allow them the flexibility of booking appointments at their convenience. 

The same goes for your billing and payment systems. An automated billing system ensures that your staff does not spend the bulk of their time working on billing for each patient’s visit and procedures. Providing multiple options for patients to make payments makes the process go faster for your patients and you. 

A Mobile app which allows for all these processes makes things go even faster and reduces the need for backend management by your staff. 

5. Reduce overbooking and wait times

Overbooking may be an accepted practice in the hospitality industry, but it may not fly well with your patients. It leaves them frustrated as dental care is a necessity rather than a source of entertainment. This can negatively impact your efforts for patient retention at your dental practice. Planning appointments carefully while keeping in mind the procedures that your patients may need will also reduce their wait times at your clinic. This is a great way to elevate the patient experience at your practice. Waiting for extended periods of time for a service that they have booked for can be a legitimate reason for them to feel frustrated and will reduce their favor. By respecting their time, you are making them feel valued and cherished. 

6. Address concerns upfront

Have regular surveys done to give your patients an opportunity to be honest about your services and their experience at your practice. Something as simple as setting up an automatic survey can be just the right step to receive great input from your patients for improvements and ultimately help in effective patient retention. This will give your patients an opportunity to raise any concerns they may have.

Of course, having surveys and feedback mechanisms in place would be pointless if you do not address concerns or implement feedback on time. Your patients should not feel that their voices are not being heard. Connect with them once the feedback has been implemented and let them know of the changes you have made to make them feel extra special.   

Keep a check on reviews that your patients leave on review sites and social media as well. Address any concerns that they may have and thank them for leaving their feedback on these sites. 

Remember, every interaction is an opportunity, especially considering patients are walking testimonials for your practice. Your existing patients become your source for new patients.

Organizing Your Claims Billing Process

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Claims billing is a multi-step process involving several people and types of data like patient-related information and clinical documentation. Not setting up a robust claim filing and billing system can possibly be the worst mistake that a practice can make in their revenue cycle. Understanding the fundamentals can help providers and practices ensure that the number of claims that go unpaid or denied remains as low as is possible. Understanding claims billing starts with learning about the various steps involved and improving the efficiency of each step.

Maintaining Thorough and Accurate Data

This is a continuous process that starts at the outset of a patient’s and provider’s relationship. All the relevant information collected before and during the cycle of services provided, needs to be entered into the billing system accurately. During this process, all the documents must be scrutinized and verified. These documents include:

  • Social Security numbers of patients
  • Tax Identification numbers of providers
  • Addresses of patients and providers
  • Details of procedures done
  • Any X-rays or charting that needs to be done
  • Pre-authorization documentation, when required

It is always better to provide more data than less when it comes to the services provided at a practice. 

Any errors found must immediately be rectified and any missing information should be collected and included. This helps in preparing more accurate claims, thereby reducing the risk of claim denials.

Applying accurate standardized codes

CDT codes are a collection of codes used to identify the various procedures and services provided for oral health and dentistry. There is a vast array of these codes which go through frequent additions, deletions, and modifications each year. Staying on top of these changes and ensuring that the right codes are used, is another vital step in the claims billing process.

Looking for limitations, frequencies, and exclusions

The amount an insurance provider pays out depends on several factors, not least of which are limitations on the amount covered for certain procedures, the number of times some procedures are covered in a particular policy year and even the patient’s age. These limitations, frequencies and exclusions affect every claim, and this is the reason information on these is usually collected before a service is provided. Unrecognized exclusions or limitations in the insurance coverage could result in claim rejections and denials.

Quality check

The final step, pre-submission of bills, is always a review of the prepared claim. This is done as an attempt at ensuring that all possible mistakes are eliminated, reducing the chances for claim denials. Vital pieces of information that need to be reviewed are: 

  • Accuracy of procedural codes
  • Patient information and data
  • Insurance provider data
  • Provider data
  • Insurance limitations, frequencies, and exclusions

Evaluating and resolving denied claims

Submission of claims can be incorrectly considered as the last step in the claims billing process. However careful a practice is while preparing and submitting a claim, there is always the possibility of claims getting denied and procedures going unpaid due to human error. Reworking such claims is another step that gets added due to such denials and non-payments, and this rework needs to be done without any delays. 

Periodic review of previously denied claims is also a great way to learn from mistakes made in the past. Implementing the learnings from such reviews helps build a better claims billing system, which in turn reduces the chance of future denied claims and unpaid procedures.

Maintaining continuous communication with patients and the insurance provider

While continuous communication may not be an established custom in the billing process, it is an important phase for the dental revenue cycle management of a practice. It helps reduce the time and effort that is necessary to file claims. Staying in touch with your patients not only improves the reliability of your practice but also quickens and improves your revenue cycle. 

Having a well-managed and efficient claims billing system is the key to a successful revenue cycle management. It helps minimize the workload of your staff and helps to ensure that the focus is always on what is most important, excellent dental care and patient satisfaction.

Determine Patient Responsibility & Collect Payments Faster

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Given the rise in high-deductible payment plans (HDHP) and patients choosing to shoulder more and more of the financial obligations for treatments and services received, determining patient responsibility has become priority for a practice. Instead of relying on insurance providers for payment collections, practices rely more on their patients to bolster their revenue cycle. They are forced to find ways to collect more of these patient responsibility balances in order to secure maximum revenue. This is not as easy as it would seem. Estimating and collecting patient responsibility involves keeping meticulous records and ensuring on-time follow-up. You do all this while establishing maximum patient satisfaction and them consistently choosing your practice over others and leaving positive reviews.

What is patient responsibility and payment collection?

The portion of a dental bill that the patient must pay out-of-pocket, not from their insurance company, is known as patient responsibility. It is the amount that the patients owe to their practice for dental services rendered. Deductibles and co-pays are perfect examples of this. Payment collection is simply the process of securing the patient payment.

How can you improve your patient responsibility payment collection?

Keep a payment plan ready

It is always better for practices to keep a the payment plan ready for their patients. Having a proper payment plan can help you set up an efficient payment process to follow while attempting to collect on patient responsibility balances. It also reduces the chance of patients defaulting due to them not being aware of their responsibility. Following an established plan will help the patient responsibility collection process go smoothly. Given the complexity and diversity of healthcare plans, it may seem difficult to create estimates for each patient, but it cannot be avoided.

Don’t tiptoe around payment conversations

A conversation about patient payment responsibility may be uncomfortable to have but tiptoeing around the issue is never a solution. Getting your revenue is ultimately what your aim is. Be clear and direct. Your patients may already be confused and stressed about a lot of things, and you don’t want to make it even more difficult for them. Make sure that you convey the details of their responsibilities in a simple and easy manner. 

Let the patient know in advance about their payment responsibility

Most practices fail to remind their patients of their payment responsibility prior to the services without realizing the impact it could have on their payment collection process. Avoid surprises by informing your patient about their treatment plan and financial commitment right at the beginning. Patients are more inclined to pay when they know in advance exactly how much they owe. Let them know about any deductibles, co-pays, and also give them an approximate estimation of the co-insurance amount. Conveying the probability of there being unexpected changes in the procedures or services is also something you should ideally do, as these changes could also result in changes in the payment responsibility of the patient.

Patients need to be prepared for the expenses that they will incur, for a quicker payment process. You also need to convey the potential for unexpected changes in payment amounts as changes in procedures can cause the final amount to differ. Remember, collecting from a patient requires a lot more effort than collecting from an insurance provider. This effort would magnify in cases where the patients are not aware of their payment responsibility prior to the visits, which is most of the time.

Provide multiple payment options

Having multiple payment options can benefit your practice in a lot of ways. It shows the patients that you are considering their convenience as opposed to simply ensuring that you receive your revenue. Even if your patients don’t have enough money on hand, they can easily opt for any other modes of payment such as debit or credit cards, checks, charge cards and mobile payment apps. This makes the payment process much easier for them and collection smoother for you. 

Collect payments before the patient leaves the practice

Collecting payments at the time of the service is a good rule to follow. It’s always a good idea to get the payment from the patient before they leave the practice. Never leave any of the patient responsibility balances for future, especially if the patients owe more than the insurance provider. This increases the risk of payments going unpaid. In a lot of cases, late attempts to collect the payment can be exceedingly time-consuming and challenging. 

Stay in touch with your patients

Remember to continuously stay in touch with your patients. This not only helps in building a bond with them but also helps in quicker patient payments. After initially informing the patient about their patient responsibility, make sure that you send reminders so that they don’t miss their payment due dates. Remember that your patients are also busy and paying for one specific service may not always be a priority for them. A reminder may be just what they need. This can help your practice maintain a faster and more efficient payment cycle.

Partner with an RCM Service provider

Focusing on the actual practice may become onerous if you are constantly worrying about patient responsibility. With a dental RCM service provider by your side, you will not have to worry about any of these as they help you manage all your RCM-related worries, including patient payment collection. Your RCM service provider works closely with your patients and makes sure that the full patient payments are collected on time allowing you to concentrate on the actual dental service.

Payment Posting Doesn’t Have To Be Hard

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Almost all practices struggle with it payment posting and find it hard to balance their time and effort between payment posting and other processes in RCM while managing the important needs of the practice. But payment posting is not something that can be negotiated or ignored as it is one of the crucial elements for the smooth flow of your revenue cycle. It provides a brief overview of your practice’s financial health. With proper management, your payment posting process can be made easier and smoother.

So, what exactly is payment posting?

It is a process in dental revenue cycle management wherein the payment details are logged into the patient system to give the practice a broad perspective of all the payment information and explains how different payers’ collections work. It helps in gaining a better understanding of your practice’s day-to-day financial status and aids in enhancing your cash flow.

The payment posting cycle starts just after the submission of claims to the insurance providers. The practice then waits for the decision of the insurance providers. They may pay for claims or reject them. In either case, the practice receives an E.O.B (explanation of benefits) from the payer. If the claim has been accepted, the payer sends the payment amount via check or EFT along with the E.O.B. The process of payment posting ends when the payment or denial details are settled under the patient’s account. Remember, understanding the financial picture of your practice can help you identify income leakage and take fast action to fix it.

Payment posting processes

Patient payments

All patient payments, including co-pays, deductibles, and payments from those without insurance, need to be documented for proper payment posting. Payments are deposited in the bank and reconciled with the practice’s general ledger to ensure that they match what was recorded in the practice’s management system.

Patient payment responsibilities

Important patient responsibilities, such as co-pays, non-covered services, and so on, must be identified and communicated to the patient right at the beginning. This helps in making the payments flow faster and in avoiding any misunderstanding related to financial obligations.

Balancing write-offs

The specific levels for write-offs and modifications for each client should be indicated in the process of payment posting in detail. Any requests for deviations must be acknowledged without delay, and the necessary steps need to be taken to prevent revenue loss.

Denial posting

Claim denial information must be posted into the patient’s practice management system based on which the write-off decisions can be made. Also, based on this information, necessary actions such as billing the secondary payer, transferring the balance to the patient account, making adjustments/write-offs as per defined policies, and routing the denied claims to appropriate work queues can be taken.

Why Should You Pay Attention To Your Accounts Receivable Days

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Accounts Receivable days, or AR days, are one of the crucial performance indicators that determine the success of a practice. Accounts Receivable  indicates the payment amount that has not yet been collected from the patients or the insurance providers.  Accounts Receivable is basically the amount owed to the practice, and AR days refer to the amount of time it takes to get the complete payment for a claim. An increase in AR days can lead to a decrease in the revenue of the firm. Therefore, it becomes highly important to have proper Accounts Receivable management. Proper and careful AR management can help in increasing the overall revenue of your practice. Higher accounts receivable days can have a negative impact on the overall operation of your practice. It can negatively affect the quality of patient care and treatment, which in turn can affect the patient experience, leading to patients losing trust and contentment in your practice. For the healthy working of your practice, it is important to manage your Accounts Receivable so as to reduce your days in AR.

Here’s why you should pay more attention to your AR days:

  • To receive maximum reimbursement from insurance companies.

 The AR management team makes sure that the claims are submitted or resubmitted to the insurance payers properly without any delay. They ensure reduced AR days by making sure that all the required steps are taken to collect the money if the claim is underpaid so that the practice receives maximum reimbursement.

  • Cut down the cost, time and effort that go into the resubmission of claim denials.

 Proper AR management helps in handling claim denials without any loss in time or money as fast as possible.

  • Proper AR management helps in tracking denied claims.

It helps in identifying and analyzing the reasons for claim denials and submits appeals for these denied claims on a timely basis. Thus reducing the AR days.

  • Helps keep track of the amount that goes into the aged category every month.

 This is one of the many crucial aspects of maintaining a healthy revenue cycle as accounts that are aged over 90 days are at a high risk of turning into unpaid claims. Proper management of AR days thus helps in avoiding insurance going unpaid.

  • Helps in identifying the customers or accounts that are at high risk of being unpaid.

It helps to identify late payers, thus helping the practice in taking measures to prevent the same. It also effectively reduces the AR days by helping the practice take appropriate actions to guarantee that the payment is precisely collected if the majority of the past-due amount can be attributed to a single customer.

  • Helps in faster claims submissions

With the proper management of accounts receivable, you can make sure that the practice is submitting the claims to the payers without any delay. Any delay in the submission of claims can cause a lot of trouble for the smooth functioning of the practice therefore it is important to make sure that the claims are submitted as soon as possible so that the AR days remain low.

  • Helps ensure the smooth functioning of the practice.

Fewer AR days help in increasing the overall revenue of the practice, which in turn provides the practice with the money to recruit and pay their staff, get new and improved technology and high capital for expansion. 

  • Helps improve the patient experience.

With the decrease in AR days, the quality of patient care and patient experience increases, thus building the trust and contentment of the patients. 

Accounts Receivable Management

Accounts receivable management services include the administration of reports pertaining to insurance, write-offs, bad debt evaluations, collection analysis, and ratio analysis. They are responsible for the management of denied claims, finding the reasons and analyzing claim denials so as to maximize patient payment and increase the overall revenue of the practice, effectively decreasing the AR days. Therefore, managing accounts receivable requires a great deal of knowledge about the various reasons for claim denials and the ways to reduce them. Don’t shy away from contacting the insurance providers or the patients for a better understanding of the reasons for claim denials or if any related doubts need to be cleared. Go through the claims thoroughly, making sure they are accurate and error-free, before the claim submission. The AR management also needs to do proper follow-up on patients and the accounts of patients who do not make timely payments need to be monitored continuously to help the practice in taking the proper action needed to reduce such instances from happening again. By properly tracking denied claims and appealing for them, AR management helps a practice collect the maximum portion of accounts receivable. Successful accounts receivable management requires careful planning and the allocation of appropriate resources to achieve maximum performance.

Why consider an RCM service provider

Reducing Accounts receivable days is crucial for the smooth functioning of your practice, but it can be a constant struggle for the dentists as well as the staff, because any error or negligence in AR management can result in poor cash flow and loss in revenue. Managing the various aspects of the revenue cycle, including Accounts receivable management, along with patient care can be a hectic task for the practice. Therefore, hiring an expert RCM service provider can be the perfect solution as they help your practice with managing the various AR-related processes thereby helping in decreasing the AR days and increasing the revenue of the practice. They provide you with expert professionals specializing in AR management and make sure that your practice is successful and equipped to treat more patients. They help your practice reduce its Accounts receivable days by increasing the claim acceptance ratio. They help you do a proper follow-up on denied claims and resubmit them as soon as possible so that the chances of claims going unpaid can be reduced, thus reducing any loss in revenue due to claim denials. They make sure that payments are collected on time and do proper follow-ups on patient accounts. Thus, you don’t have to allot extra time or effort for any of these processes and can provide your full-on attention to other important needs of the dental practice, like improving patient care. It gives the practice the opportunity to focus more on patient care and its expansion while letting your dental RCM service provider handle all the complex and difficult tasks of revenue cycle management.

Preauthorization In Revenue Cycle Management

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  Pre-authorization is permission from an insurance company that is required before a patient can receive a certain type of treatment, care, or service. Virtually every payer requires pre-authorization for physical, occupational, and speech therapy. In most cases, if pre-authorization is not secured, services will not be covered by insurance. Most often, either the provider or the patient will be stuck with the bill for the entire cost of care.

Preauthorization refers to the practice of acquiring approval from insurers in advance for certain treatments and procedures in order to receive a possible reimbursement for those services. In other words, it is permission from an insurance company that is required before a patient can receive a certain type of treatment, care, or service. Virtually every payer requires pre-authorization for physical, occupational, and speech therapy. In most cases, if pre-authorization is not secured, services will not be covered by insurance. Most often, either the provider or the patient will be stuck with the bill for the entire cost of care. However, a majority of healthcare professionals feel that prior authorizations are time-consuming and interfere with patient treatment. The crux of the matter is that though pre-authorization does not guarantee reimbursement, the absence of pre-authorization can surely result in claim denials or non-reimbursement. Once you acquire pre-authorization from a payer, you will get a pre-authorization number. This number must be included in your claims to avoid unnecessary denials. If your claims are denied based on the lack of medical necessity, you should append this pre-authorization number while preparing an appeal letter.

To answer the most important question,

“How does preauthorization help your practice?”

  • Preauthorization in medical billing helps healthcare organizations collect the proper payment for services rendered, reduce rejections and follow up on rejected claims.
  • Preauthorization is a part of insurance verification and therefore, helps ensure that the insurance details of patients are valid.
  • Preauthorization is a way to ensure that the payer will pay the reimbursement amount without much delay.
  • Preauthorization aids in the verification of insurance details and helps to curb insurance fraud by removing erroneous insurance claims.
  • Preauthorization helps to avoid denials by obtaining payment approval from the insurance provider prior to providing the services.
  • Preauthorization allows insurance providers to assess whether a patient’s condition warrants further dental care or treatment.

Preauthorization is not as easy as it seems; there are many challenges involved. These challenges include:

Time consuming

Preauthorization  in revenue cycle management consumes so much time that they become an added burden on your staff. To successfully complete preauthorization, a lot of steps need to be followed. They include filling out request forms and submitting it to the insurance providers. A lot of time goes into the collection and verification of all the information required to process a prior authorization request. Not having a pre authorization can lead to patients not getting their treatments and creating some discord at your practice.

Complexities in Preauthorization

Preauthorization in revenue cycle management can be much more complex than perceived. It can be a tumultuous task for your practice to keep up with the constantly changing policies and codes. As a result, your practice would be compromised if these changes are not implemented swiftly or there may have occurred unnecessary preauthorization in revenue cycle management  submissions.

Lack of transparency

Lack of communication between the practice and the insurance providers regarding the status of the preauthorization request can result in delays and costly back-and-forths between them. Lack of transparency can lead to a lot of confusion, which results in another set of discomfort at your practice. Therefore, it is important to have proper transparency between the practice and the insurance provider.

So many insurances and even more insurance plans

There are so many payers in the market with so many more insurance plans, each having their own set of terms and conditions.

Some standards for prior authorization have been set. So, get to know some of the best practices:

  • The use of prior authorization related to emergency care is prohibited by the Affordable Care act.
  • There is a move to ban prior authorization for certain behavioral health care by some states in the United States of America.
  • The law in some states requires the use of standardized prior authorization methods and new transparency reporting.
  • The use of “gold card” laws that requires health plans to waive prior authorization for services ordered by providers with a track record of prior authorization approval has been adopted by some states in the US, while other states are considering doing the same.

Application request for preauthorization

Ensure the completed form with your request for preauthorization is bereft of any errors. Errors in your application requesting preauthorization would inevitably lead to your request being rejected. 

Submit all relevant documents on time

While submitting your preauthorization request, remember to submit all the supporting documents within the given timeframe.

Adhere to the guidelines

Preauthorization in revenue cycle management is dependent on many factors. Of these, medical necessity takes credence. Remember, not all procedures or treatments require preauthorization.

For example:

  • If a patient has had a medical emergency or needs emergency treatment, (it is not required) obtaining a preauthorization is not a requirement since it may take 5 to 10 days for the insurance provider to respond to your preauthorization request.
  • There has been a move to ban prior authorization for certain behavioral health care by some states in the United States of America.
  • The law in some states requires the use of standardized prior authorization methods and new transparency reporting.
  • The use of “gold card” laws that requires health plans to waive prior authorization for services ordered by providers with a track record of prior authorization approval has been adopted by some states in the US, while other states are considering doing the same.